Cancer Health Literacy and Its Correlated Factors in the United Arab Emirates-A Cross Sectional Study.

INTRODUCTION: Cancer Health literacy (CHL) is the health literacy related to cancer knowledge, prevention, treatment, screening, and access to services. It is an important indicator of people's adherence to screening and preventive measures, which helps to reduce the incidence and prevalence of cancer. The study assessed the CHL level and its association with relevant socio-demographic characteristics and sources of information among primary health care patients and visitors in the United Arab Emirates (UAE). METHODS: A cross-sectional study recruited survey participants who consented to respond to an interviewer-administered questionnaire. The assessment of CHL was done by using 15 questions. CHL level was measured as a median score and also categorized as poor/inadequate, moderate, good/excellent. Nominal logistic regression was used to analyze the relationship between CHL categories and participants' sociodemographic characteristics and CHL sources of information. RESULTS: Of the total 492 participants, 45.5% were young adults (30-39 years old), 32.9% were males, and 70.8% were UAE nationals. The overall median CHL score was 8.0 (IQR = 5.0-10). 33.7% of the participants had a poor/inadequate level of CHL, 49.6% had a moderate level and 16.7% had a good to excellent level of CHL. 76.9% of the participants knew the importance of early cancer screening tests, 72.7% acknowledged the metastatic capacity of cancer, and the protective factors of cancer, especially, in colon cancer (71.7%). A high proportion of participants received health information about cancer via the internet (50.7%), television (45.3%), social media (40.2%), and doctors (43.6%). Nationality other than UAE (aOR = 1.62, 95% CI = 1.03-2.56, P = .038), having university education (aOR = 2.20, 95% CI = 1.21-3.99, P = .010) compared to those with lower than high school, and having a family history of cancer (aOR = 2.42, 95% CI = 1.33-4.41, P = .004) were positively associated with CHL. Older age (aOR = .36, 95% CI = .17-.75, P = .007 for 50-59 years, and aOR = .29, 95% CI = .11-.82, P = .019) for 60-69 years, higher-income (aOR = .57, 95% CI = .33-.99, P = .047 for 10,000-19,999 AED; aOR = .53, 95% CI = .33-.88, P = .013 for ≥20,000) compared with those earning <10,000 AED were negatively associated with CHL. CONCLUSIONS: CHL among the resident UAE population was moderately adequate, therefore implementation of awareness campaigns seems to be warranted. Moreover, evaluation research targeting the CHL impact on cancer prevention practices and screening is also advocated.

Temporal trends of hemoglobin among pregnant women: The Mutaba'ah study.

BACKGROUND: Low hemoglobin (Hb) level is a leading cause of many adverse pregnancy outcomes. Patterns of changes in Hb levels during pregnancy are not well understood. AIM: This study estimated Hb levels, described its changing patterns across gestational trimesters, and identified factors associated with these changes among pregnant women. MATERIALS AND METHODS: Data from the ongoing maternal and child health cohort study-The Mutaba'ah Study, was used (N = 1,120). KML machine learning algorithm was applied to identify three distinct cluster trajectories of Hb levels between the first and the third trimesters. Descriptive statistics were used to profile the study participants. Multinomial multivariable logistic regression was employed to identify factors associated with change patterns in Hb levels. RESULTS: The three identified clusters-A, B and C-had, respectively, median Hb levels (g/L) of 123, 118, and 104 in the first trimester and 119, 100, and 108 in the third trimester. Cluster 'A' maintained average normal Hb levels in both trimesters. Cluster 'B', on average, experienced a decrease in Hb levels below the normal range during the third trimester. Cluster 'C' showed increased Hb levels in the third trimester but remained, on average, below the normal range in both trimesters. Pregnant women with higher gravida, diabetes mellitus (type 1 or 2), nulliparity or lower level of education were more likely to be in cluster 'B' than the normal cluster 'A'. Pregnant women who reported using iron supplements before pregnancy or those with low levels of education. were more likely to be in cluster 'C' than the normal cluster 'A'. CONCLUSION: The majority of pregnant women experienced low Hb levels during pregnancy. Changes in Hb levels during pregnancy were associated with parity, gravida, use of iron before pregnancy, and the presence of diabetes mellitus (type 1 or 2).

Happiness and associated factors amongst pregnant women in the United Arab Emirates: The Mutaba'ah Study.

OBJECTIVE: Prenatal happiness and life satisfaction research are often over-shadowed by other pregnancy and birth outcomes. This analysis investigated the level of, and factors associated with happiness amongst pregnant women in the United Arab Emirates. METHODS: Baseline cross-sectional data was analyzed from the Mutaba'ah Study, a large population-based prospective cohort study in the UAE. This analysis included all expectant mothers who completed the baseline self-administered questionnaire about sociodemographic and pregnancy-related information between May 2017 and July 2021. Happiness was assessed on a 10-point scale (1 = very unhappy; 10 = very happy). Regression models were used to evaluate the association between various factors and happiness. RESULTS: Overall, 9,350 pregnant women were included, and the majority (60.9%) reported a happiness score of ≥8 (median). Higher levels of social support, planned pregnancies and primi-gravidity were independently associated with higher odds of being happier; adjusted odds ratio (aOR (95% CI): 2.02 (1.71-2.38), 1.34 (1.22-1.47), and 1.41 (1.23-1.60), respectively. Women anxious about childbirth had lower odds of being happier (aOR: 0.58 (0.52-0.64). CONCLUSION: Self-reported happiness levels were high among pregnant women in the UAE. Health services enhancing social support and promoting well-being during pregnancy and childbirth may ensure continued happiness during pregnancy in the UAE.

The prevalence and correlates of depression among patients with chronic diseases in the United Arab Emirates.

BACKGROUND: Chronic diseases constitute a major public health problem in the United Arab Emirates (UAE) and are the leading cause of mortality and morbidity. Chronic diseases have been found to be associated with an increased prevalence of depression and depressive symptoms. Depression can have detrimental effect on the prognosis of the disease and quality of life in patients. AIMS AND OBJECTIVES: This study aimed to estimate the prevalence and correlates of depression in a sample of patients suffering from chronic disease in Al-Ain city, UAE. MATERIALS AND METHODS: A cross-sectional survey based study was conducted with 417 participants recruited from seven primary health care centers of Al-Ain city. Men and women aged 18 years and above suffering from chronic disease filled the Patient Health Questionnaire (PHQ-9). Univariate and multivariable logistic regressions were performed on the collected data to investigate correlates of different factors with depression. Data was analyzed using SPSS (version 26). The study was approved by Ambulatory Healthcare Services (AHS) Human Ethics Research Committee. RESULTS: The majority 62.41% (n = 254) of the sample were females, 57.97% (n = 240) aged above 55 years and with a median (Q25, Q75) duration of chronic disease of 8 (4, 15) years. The prevalence of depression was 21.1% (95% CI: 17.5%-25.3%). With severe depression was in 1.7% and mild-moderate in 34.7% of the participants. Depression severity was statistically significantly associated with increasing age (p = 0.006), low level of education (p<0.001), presence of asthma (p = 0.007) and heart disease (p = 0.013). Unadjusted logistic regression reported that presence of depression was significantly associated with female gender (cOR = 1.8, [95% CI; 1.1-3.1], p = 0.025), and presence of chronic kidney disease (cOR = 4.9, [95% CI; 1.3-20.2], p = 0.020) and heart disease (cOR = 2.9, [95% CI; 1.6-5.4], p = 0.001) longer duration of disease in years (cOR = 1.04, [95% CI; 1.01-1.07], p = 0.003). However, in the adjusted logistic regression analysis, participants with heart disease (aOR = 2.8, [95% CI; 1.4-5.5], p = 0.004), and with longer duration of disease (aOR = 1.04, [1.01-1.07], p = 0.014) remained significantly associated statistically with higher chance of having depression. CONCLUSION: The prevalence of depression was quite high and the study highlights for health care professionals and policy makers, the importance of mental health support as part of a comprehensive management plan for patients with chronic diseases. A multidisciplinary comprehensive program will improve the long-term outcomes of these patients. Patients with chronic diseases may need more support and counseling at primary health care levels.

Tobacco Use and Exposure to Environmental Tobacco Smoke amongst Pregnant Women in the United Arab Emirates: The Mutaba'ah Study.

Self-reported tobacco use is high in the male adult Emirati population (males ~36% vs. females ~3%); however, there are minimal data on tobacco use or exposure to environmental tobacco smoke (ETS) during pregnancy in the United Arab Emirates (UAE). This study investigated the prevalence of, and factors associated with, tobacco use and exposure to environmental tobacco smoke (ETS) amongst pregnant women in the UAE. Baseline cross-sectional data were analysed from the Mutaba'ah Study. Expectant mothers completed a self-administered questionnaire collecting sociodemographic information, maternal tobacco use, and ETS exposure during antenatal visits at three hospitals in Al Ain (UAE; May 2017-February 2021). Amongst 8586 women included in the study, self-reported tobacco use during pregnancy was low (0.7%), paternal tobacco use was high (37.9%), and a third (34.8%) of expectant mothers were exposed to ETS (28.0% at home only). Pregnant women who were employed (adjusted odds ratio (aOR): 1.35, 95% confidence interval (CI): 1.19-1.52), with childbirth anxiety (aOR 1.21, 95% CI 1.08-1.36), and with an increased number of adults living in the same household (aOR 1.02 95% CI 1.01-1.03) were independently more likely to be exposed to ETS. Pregnant women with higher education levels (aOR 0.84, 95% CI 0.75-0.94) and higher gravidity (aOR 0.95, 95% CI 0.92-0.99) were less likely to be exposed to ETS. Public health efforts targeting smoking cessation amongst husbands and promoting smoke-free homes are warranted to help reduce prenatal ETS exposure in the UAE.

Effects of Diabetes Prevention Education Program for Overweight and Obese Subjects with a Family History of Type 2 Diabetes Mellitus: A Pilot Study from the United Arab Emirates.

OBJECTIVES: The association of obesity and family history of type 2 diabetes mellitus (T2DM) provides an opportunity for risk stratification and prevention, as these two conditions are the most well-known risk factors for T2DM. We aimed to test the feasibility and effects of a diabetes mellitus prevention education program designed for overweight and obese Emirati people with at least one parent with T2DM. METHODS: We conducted a pilot study using a pre-post design without a control arm at the Diabetes Center at Tawam Hospital in Al Ain, UAE. Overweight and obese subjects with at least one parent with T2DM were invited to participate. Three study assessments were conducted at baseline, three months, and six months including a questionnaire, anthropometry, and laboratory assessments. Interventions included three individualized or family-engaged counseling sessions based on the DiAlert protocol. The study outcomes included awareness of risks and prevention opportunities to T2DM, behavior changes in nutrition and exercise, decreased waist-circumference, and clinical/metabolic/inflammatory markers. Pre-post changes were analyzed using repeated-measures analysis of variance. RESULTS: One hundred twenty-two overweight or obese individuals were approached. Forty-four individuals met the eligibility criteria, and 32 individuals (35.0±9.0 years; 75.0% female) completed the study. At six months, there were significant improvements in the glycated hemoglobin levels (p = 0.007), high-density lipoprotein (p < 0.049), serum creatinine (p < 0.025), estimated glomerular filtration rate (p = 0.009), and adiponectin levels (p < 0.024). Sixteen of 32 participants had ≥ 2 cm reduction in waist circumference. They demonstrated notable physical and laboratory improvements in moderate-vigorous activity, average activity counts per day, tumor necrosis factor-alpha, and interleukin-6 total cholesterol, triglyceride, and low-density lipoprotein. CONCLUSIONS: Offering family-oriented diabetes education to people at risk for T2DM is well received and has favorable effects on relevant risk factors. Better testing with large-scale randomized controlled studies is needed, and implementing similar educational programs for the Emirati population seems warranted.

Stakeholders' Interest and Attitudes toward Genomic Medicine and Pharmacogenomics Implementation in the United Arab Emirates: A Qualitative Study.

BACKGROUND AND AIM: Mapping the power, interest, and stance of stakeholders is a cornerstone for genomic medicine implementation. In this study, we aimed at mapping the power/interest of various stakeholders in United Arab Emirates (UAE) and exploring their attitudes toward pressing health genomics aspects. The overarching aim of this study is to facilitate the construction of a road map for the full implementation of genomic medicine and pharmacogenomics in the UAE with potential applicability to many healthcare systems around the world. METHODS: A qualitative approach using in-depth interview was employed. Heterogeneous stakeholders were identified by experts in the field. The analysis of the data was a hybrid of deductive and inductive approach using NVivo software for coding and analysis. RESULTS: 13 interviews were conducted. Following mapping the Mendelow's matrix, we categorized the stakeholders in UAE to promoter, latent, defender, and apathetic. Most of the interviewed stakeholders emphasized the clinical demand for genomic medicine in UAE. However, many of them were less inclined to articulate the need for pharmacogenomics at the moment. The majority of stakeholders in UAE were in favor of building infrastructure for better genetic services in the country. Stakeholder from an insurance sector had contradicting stance about the cost-effectiveness of genomic medicine; the majority were concerned with the legal and ethical aspects of genomic medicine and had an opposing stance on direct-to-consumer kits. CONCLUSIONS: Implementing the Mendelow's model will allow the systematic strategy for implementing genomic medicine in UAE. This can be achieved by engaging the key players (promoters and defenders) as well as engaging and satisfying the latent stakeholder.

Association between duration of residence and prevalence of type 2 diabetes among male South Asian expatriate workers in the United Arab Emirates: a cross-sectional study.

Expatriates account for about 80% of the total population in the United Arab Emirates (UAE). This study aimed to evaluate the hypothesis that prevalence of type 2 diabetes in male South Asian expatriates increases with increased length of residence in the UAE. DESIGN, SETTINGS AND PARTICIPANTS: This cross-sectional study recruited a representative sample (n=1375) of male South Asian expatriates aged ≥18 years in Al Ain, UAE. Sociodemographic, anthropometric and lifestyle data were obtained using a pilot-tested adapted version of the WHO STEPS instrument. MAIN OUTCOME MEASURES: Duration of residence was used as a marker for acculturation. Type 2 diabetes was defined as a self-reported physician diagnosis of diabetes or a glycosylated haemoglobin blood level ≥6.5%. RESULTS: Mean (±SD) age of participants was 34.0±9.9 years. Overall, the prevalence of type 2 diabetes was 8.3% (95% CI 6.8% to 9.8%). Diabetes prevalence was positively associated with longer duration of residence in the UAE, 2.7%, <5 years; 8.2%, 5-10 years; and 18.8%, >10 years. After adjusting for age, nationality, and income and age, expatriates were more likely to develop diabetes if residing in the UAE for 5-10 years (OR=2.18; 95% CI 1.02 to 4.67) or >10 years (OR=3.23; 95% CI 1.52 to 6.85) compared with those residing for <5 years. CONCLUSIONS: After controlling for potential confounding factors, longer duration of residence was significantly associated with a higher prevalence of type 2 diabetes in male South Asian expatriate workers in the UAE.

Impact of Recurrent Miscarriage on Maternal Outcomes in Subsequent Pregnancy: The Mutaba'ah Study.

PURPOSE: To estimate the prevalence of recurrent miscarriage (RM) and investigate the association between RM and adverse maternal outcomes in subsequent pregnancies. PARTICIPANTS AND METHODS: This is an interim analysis of a prospective study of 1737 pregnant women with gravidity of two or more prior to the current pregnancy. These women joined the Mutaba'ah Study between May 2017 and April 2019 and were followed up until they delivered. Hospital medical records were used to extract data on past pregnancy history and the progress and outcomes of the current pregnancy, such as gestational diabetes, preeclampsia, mode of delivery, preterm delivery, and complications at birth. RESULTS: Amongst pregnant women with at least two previous pregnancies (n=1737), there were 234 (13.5%) women with a history of two or more consecutive miscarriages. Women with RM were slightly older, more parous, and more likely to have had previous infertility treatment (all p-values <0.05). Women with a history of RM had independently significant increased odds of cesarean section (adjusted odds ratio (aOR) 1.81, 95% CI 1.24-2.65) and preterm (<37 weeks, aOR: 2.52, 95% CI 1.56-4.08) or very preterm delivery (<32 weeks, aOR: 7.02 95% CI 2.41-20.46) in subsequent pregnancies than women who did not have a history of RM. CONCLUSION: Women with a history of RM were twice as likely to undergo cesarean section and seven times more likely to deliver prior to 32 weeks of gestation than women without a history of RM. The study findings support the need for early pregnancy monitoring or assessment units to ensure better follow-up and customized care for at-risk pregnant women with a history of RM.

Environmental assessment of cytotoxic drugs in healthcare settings: protocol for a systematic review and meta-analysis.

BACKGROUND: Occupational exposure to cytotoxic drugs is associated with various unfavorable health outcomes. This protocol reports a methodology for a systematic review and meta-analysis that aims to systematically review the published literature and quantify the level of environmental contamination of healthcare settings with cytotoxic drugs. METHODS: This protocol is developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol-2015 (PRISMA-P) guidelines. Six electronic databases (PubMed, Web of Science, Scopus, Cochrane Library, CINAHL, and EMBASE) will be searched with no restrictions on publication period. Eligible studies will be identified and data will be extracted using a predefined data extraction form by at least two independent reviewers following best practice. Eligible studies should report calculated or calculable estimates on the proportion of positive samples tested for cytotoxic drugs and/or estimates on the concentration of the cytotoxic drug(s) in the tested samples. Risk of bias (RoB) will be assessed by using the RoB in Studies estimating Prevalence of Exposure to Occupational risk factors (RoB-SPEO) tool, which developed by the World Health Organization (WHO) and International Labour Organization (ILO) for environmental and occupational health systematic reviews. The random-effects model will be used to perform meta-analyses. DISCUSSION: Occupational exposure to cytotoxic drugs is associated with short- and long-term adverse health outcomes. Following this protocol, the review to be carried out will be the first to fill an evidence gap on the environmental contamination of healthcare settings with cytotoxic drugs. The findings of this review will help in the understanding of the risk of occupational exposure of healthcare workers to cytotoxic drugs and facilitate the identification of priority areas for specific interventions. ETHICS AND DISSEMINATION: The systematic review methodology does not require ethics approval due to the nature of the study design. The results of the systematic review will be published in a peer-reviewed journal and will be publicly available. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020162780 , dated July 14, 2020.

Antenatal Care Initiation Among Pregnant Women in the United Arab Emirates: The Mutaba'ah Study.

Introduction: Antenatal care (ANC) provides monitoring and regular follow-up of maternal and fetal health during pregnancy. Women with appropriate ANC tend to have better delivery and birth outcomes. This study describes the patterns of ANC utilization and factors associated with appropriate ANC initiation in the United Arab Emirates (UAE) for the first time. Methods: Baseline cross-sectional data from pregnant women who participated in the Mutaba'ah-Mother and Child Health Study between May 2017 and January 2019 was analyzed. Participants were recruited during ANC visits and completed a self-administered questionnaire that collected socio-demographic and pregnancy-related information and assessed whether it was their first ANC appointment. Regression models assessed the relationship between socio-demographic and pregnancy-related variables and "appropriate" (≤ 4 months' gestation) vs. "late" ANC initiation (>4 months' gestation). Results: At recruitment, 841 participants reported that it was their first ANC visit and half (50.2%) of these women were late initiating their ANC. Mothers who were more educated, had previous infertility treatment or previous miscarriages were all more likely to achieve appropriate ANC initiation [adjusted odds ratio (aOR): 1.66, 95% confidence interval (CI): 1.05-2.62; aOR: 3.68, 95% CI: 1.50-9.04; aOR: 1.80, 95% CI: 1.16-2.79, respectively]. Women worrying about childbirth were less likely to achieve appropriate ANC initiation (aOR: 0.54, 95% CI: 0.34-0.85). Conclusion: Half of pregnant women in this study did not achieve the global consensus guidelines on appropriate ANC initiation. Interventions among less educated women and those with previous pregnancy complications and childbirth anxiety are recommended to ensure appropriate ANC initiation.

Maternal and birth cohort studies in the Gulf Cooperation Council countries: a systematic review and meta-analysis.

BACKGROUND: We systematically reviewed and chronicled exposures and outcomes measured in the maternal and birth cohort studies in the Gulf Cooperation Council (GCC) countries and quantitatively summarized the weighted effect estimates between maternal obesity and (1) cesarean section (CS) and (2) fetal macrosomia. METHODS: We searched MEDLINE-PubMed, Embase, Cochrane Library, Scopus, and Web of Science electronic databases up to 30 June 2019. We considered all maternal and birth cohort studies conducted in the six GCC countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates (UAE)). We categorized cohort studies on the basis of the exposure(s) (anthropometric, environmental, medical, maternal/reproductive, perinatal, or socioeconomic) and outcome(s) (maternal or birth) being measured. Adjusted weighted effect estimates, in the form of relative risks, between maternal obesity and CS and fetal macrosomia were generated using a random-effects model. RESULTS: Of 3502 citations, 81 published cohort studies were included. One cohort study was in Bahrain, eight in Kuwait, seven in Qatar, six in Oman, 52 in Saudi Arabia, and seven in the UAE. Majority of the exposures studied were maternal/reproductive (65.2%) or medical (39.5%). Birth and maternal outcomes were reported in 82.7% and in 74.1% of the cohort studies, respectively. In Saudi Arabia, babies born to obese women were at a higher risk of macrosomia (adjusted relative risk (aRR), 1.15; 95% confidence interval (CI), 1.10-1.20; I2 = 50%) or cesarean section (aRR, 1.21; 95% CI, 1.15-1.26; I2 = 62.0%). Several cohort studies were only descriptive without reporting the magnitude of the effect estimate between the assessed exposures and outcomes. CONCLUSIONS: Cohort studies in the GCC have predominantly focused on reproductive and medical exposures. Obese pregnant women are at an increased risk of undergoing CS delivery or macrosomic births. Longer-term studies that explore a wider range of environmental and biological exposures and outcomes relevant to the GCC region are needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017068910.

Screen time and metabolic syndrome among expatriate adolescents in the United Arab Emirates.

BACKGROUND: Both screen time and metabolic syndrome (MetS) are associated with health outcomes. However, limited data exist on the association between screen time and MetS among expatriate adolescents living in United Arab Emirates (UAE). METHODS: We conducted a cross-sectional school-based study on 473 expatriate adolescents (47% girls) aged 12-18 years in Al-Ain district of Abu Dhabi Emirates in the UAE. Data was collected with the expertise of trained nurses & IDF criteria was used to define MetS. Information on screen time (computer, television, and video game use combined) during a regular day was self-reported, and divided into two categories: <2, or ≥2 h per day. Using logistic regression analyses, adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated for the association between screen time and MetS. RESULTS: A high proportion of adolescents (75.3%) spent ≥2 h daily on screen. The prevalence of MetS was 8.5% in those with <2 h per day of screen time compared with 13.5% in those who reported ≥2 h per day. There was a graded positive association between screen time and MetS (P-trend = 0.01). Each hour increase in screen time was associated with 21% (OR, 1.21; 95% CI, 1.08-1.35) greater likelihood of having MetS. The adjusted OR value associated with ≥2 h of daily screen time was 2.20 (95% CI, 1.04-4.67), compared with adolescents who spent less than 2 h of daily screen time. CONCLUSION: Higher screen time by expatriate adolescents was associated with increased likelihood of having MetS.

Mutaba'ah-Mother and Child Health Study: protocol for a prospective cohort study investigating the maternal and early life determinants of infant, child, adolescent and maternal health in the United Arab Emirates.

INTRODUCTION: Early life exposures, particularly environmental and parental lifestyle factors, have a major influence on children's health and development. Due to increasing interest in the early life developmental origins of diseases, many birth cohorts have been established. These studies constitute a repository of data which researchers use over many years to investigate emerging research questions. However, no such databank or cohort study is available in the United Arab Emirates (UAE). This project aims to establish a prospective mother and child cohort study in Al Ain (Abu Dhabi, UAE) to investigate the maternal and early life determinants of infant, child, adolescent and maternal health of the Emirati population. METHODS AND ANALYSIS: During the period 2017-2021, this study aims to recruit 10 000 pregnancies at approximately 12 weeks of gestation from hospitals and clinics in Al Ain city. For each mother/newborn pair, an initial dataset will be collected including anthropometric, physiological and biochemical measurements, medical interventions, circumstances of pregnancy, delivery details and neonatal and perinatal growth and health using a combination of questionnaires, interviews and medical record extractions. Baseline data will act as the starting point from which the children will be followed up and re-surveyed at intervals throughout their life course until the age of 16 years, to explore how familial, socioeconomic and lifestyle factors interact with genetic and environmental factors to influence health outcomes and achievements later in life. ETHICS AND DISSEMINATION: Ethical approval has been granted by the United Arab Emirates University Human Research Ethics Committee and the ethical committees of the participating institutions. Results will be widely disseminated via peer-reviewed manuscripts, conference presentations, media outlets and reports to relevant authorities.

Patterns of tobacco use in the United Arab Emirates Healthy Future (UAEHFS) pilot study.

INTRODUCTION: Self-reported tobacco use in the United Arab Emirates is among the highest in the region. Use of tobacco products other than cigarettes is widespread, but little is known about specific behavior use patterns. There have been no studies that have biochemically verified smoking status. METHODS: The UAE Healthy Future Study (UAEHFS) seeks to understand the causes of non-communicable diseases through a 20,000-person cohort study. During the study pilot, 517 Emirati nationals were recruited to complete a questionnaire, provide clinical measurements and biological samples. Complete smoking data were available for 428 participants. Validation of smoking status via cotinine testing was conducted based on complete questionnaire data and matching urine samples for 399 participants, using a cut-off of 200ng/ml to indicate active smoking status. RESULTS: Self-reported tobacco use was 36% among men and 3% among women in the sample. However, biochemical verification of smoking status revealed that 42% men and 9% of women were positive for cotinine indicating possible recent tobacco use. Dual and poly-use of tobacco products was fairly common with 32% and 6% of the sample reporting respectively. CONCLUSIONS: This is the first study in the region to biochemically verify tobacco use self-report data. Tobacco use in this study population was found to be higher than previously thought, especially among women. Misclassification of smoking status was more common than expected. Poly-tobacco use was also very common. Additional studies are needed to understand tobacco use behaviors and the extent to which people may be exposed to passive tobacco smoke. IMPLICATIONS: This study is the first in the region to biochemically verify self-reported smoking status.

Maternal and birth cohort studies in the Gulf Cooperation Council countries: protocol for a systematic review and narrative evaluation.

INTRODUCTION: Cohort studies have revealed that genetic, socioeconomic, communicable and non-communicable diseases, and environmental exposures during pregnancy may influence the mother and her pregnancy, birth delivery and her offspring. Numerous studies have been conducted in the Gulf Cooperation Council (GCC) countries to examine maternal and birth health. The objectives of this protocol for a systematic review are to systematically review and characterise the exposures and outcomes that have been examined in the mother and birth cohort studies in the GCC region, and to summarise the strength of association between key maternal exposures during pregnancy (ie, body mass index) and different health-related outcomes (ie, mode of birth delivery). The review will then synthesise and characterise the consequent health implications and will serve as a platform to help identify areas that are overlooked, point out limitations of studies and provide recommendations for future cohort studies. METHODS AND ANALYSIS: Medline, Embase, Cochrane Library and Web of Science electronic databases will be comprehensively searched. Two reviewers will independently screen each study for eligibility, and where discrepancies arise they will be discussed and resolved; otherwise a third reviewer will be consulted. The two reviewers will also independently extract data into a predefined Excel spreadsheet. The included studies will be categorised on the basis of whether the participant is a mother, infant or mother-infant dyad. Outcome variables will be divided along two distinctions: mother or infant. Exposure variables will be divided into six domains: psychosocial, biological, environmental, medical/medical services, maternal/reproductive and perinatal/child. Studies are expected to be of heterogeneous nature; therefore, quantitative syntheses might be limited. ETHICS AND DISSEMINATION: There is no primary data collection; therefore, ethical review is not necessary. The findings of this review will be disseminated in a peer-reviewed journal and presented at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42017068910.

Genomic Medicine Without Borders: Which Strategies Should Developing Countries Employ to Invest in Precision Medicine? A New "Fast-Second Winner" Strategy.

Genomic medicine has greatly matured in terms of its technical capabilities, but the diffusion of genomic innovations worldwide faces significant barriers beyond mere access to technology. New global development strategies are sorely needed for biotechnologies such as genomics and their applications toward precision medicine without borders. Moreover, diffusion of genomic medicine globally cannot adhere to a "one-size-fits-all-countries" development strategy, in the same way that drug treatments should be customized. This begs a timely, difficult but crucial question: How should developing countries, and the resource-limited regions of developed countries, invest in genomic medicine? Although a full-scale investment in infrastructure from discovery to the translational implementation of genomic science is ideal, this may not always be feasible in all countries at all times. A simple "transplantation of genomics" from developed to developing countries is unlikely to be feasible. Nor should developing countries be seen as simple recipients and beneficiaries of genomic medicine developed elsewhere because important advances in genomic medicine have materialized in developing countries as well. There are several noteworthy examples of genomic medicine success stories involving resource-limited settings that are contextualized and described in this global genomic medicine innovation analysis. In addition, we outline here a new long-term development strategy for global genomic medicine in a way that recognizes the individual country's pressing public health priorities and disease burdens. We term this approach the "Fast-Second Winner" model of innovation that supports innovation commencing not only "upstream" of discovery science but also "mid-stream," building on emerging highly promising biomarker and diagnostic candidates from the global science discovery pipeline, based on the unique needs of each country. A mid-stream entry into innovation can enhance collective learning from other innovators' mistakes upstream in discovery science and boost the probability of success for translation and implementation when resources are limited. This à la carte model of global innovation and development strategy offers multiple entry points into the global genomics innovation ecosystem for developing countries, whether or not extensive and expensive discovery infrastructures are already in place. Ultimately, broadening our thinking beyond the linear model of innovation will help us to enable the vision and practice of genomics without borders in both developed and resource-limited settings.

Seroprevalence of measles, mumps, rubella, varicella-zoster and hepatitis A-C in Emirati medical students.

BACKGROUND: The aims of this study were to assess the seroprevalence of vaccine-preventable infections in Emirati medical students, and to provide scientific evidence for implementation of a cost-effective immunization guideline and policy for medical school admission. METHODS: This prospective cohort study involved 261 (61% female) Emirati medical students (preclinical and clinical) attending the College of Medicine and Health Sciences at UAE University. Data on vaccination and history of infectious diseases were collected from participants. Blood samples were collected between July 1, 2011 and May 30, 2012 for serological testing and QuantiFERON®-TB assay. RESULTS: All students tested negative for infection with hepatitis C virus and human immunodeficiency virus. The prevalence of seropositivity to rubella virus was 97%, varicella-zoster virus 88%, mumps virus 84%, measles virus 54%, hepatitis B virus (HBV) 48%, and hepatitis A virus 21%. The QuantiFERON®-TB test was positive in 8% and indeterminate in 2%. Forty percent of students received HBV vaccine at birth; their HBV titers (mean ± SD) were 17.2 ± 62.9 mIU/mL (median = 1.64). The remaining 60% received it at school and their titers were 293.4 ± 371.0 mIU/mL (median = 107.7, p = 0.000). CONCLUSION: About 50% of students were susceptible to HBV and measles virus; therefore, pre-matriculation screening for antibodies against these viruses is highly recommended. Moreover, tuberculosis screening is necessary because of the high influx of expatriates from endemic areas. Students with inadequate protection should be reimmunized prior to contact with patients.

Screening strategy for type 2 diabetes in the United Arab Emirates.

The prevalence of type 2 diabetes mellitus (DM) among Emirati nationals is one of the highest in the world. The recently released United Arab Emirates National DM guidelines call for screening all adults aged 30 years and more. The authors explored the need for such a modification of current American Diabetes Association (ADA) guidelines. They also considered the prevalence rates for undiagnosed DM based on oral glucose tolerance test (OGTT) versus glycohemoglobin (HbA( 1c)) >or= 6.5% in a population-based sample of 296 adult Emirati participants. In the low-risk ADA category, defined by age <45 years and BMI <25, only 1 of 68 (1.5%) participants was diagnosed with DM. The overall rate of DM based on HbA(1c) was lower than that based on OGTT (10.1% versus 14.2%; P < .05). The authors conclude that the ADA guidelines are adequate for screening in this high-risk population. They also find high discordance between HbA(1c) and OGTT.

Prevalence of diabetes mellitus and its complications in a population-based sample in Al Ain, United Arab Emirates.

AIMS: To determine the prevalence of diabetes mellitus (DM) and its complications in the adult population of the United Arab Emirates (UAE) and assess the degree of metabolic control in subjects with diagnosed DM. METHODS: A random sample of houses of Emirati citizens living in Al Ain, UAE was surveyed. Fasting blood glucose was determined by glucose meter and an oral glucose tolerance test (OGTT) was conducted if blood sugar was <7 mmol/l. DM was defined according to the WHO criteria. Pre-diabetes status was based on fasting venous blood glucose concentration of 5.6-6.9 mmol/l or 2h post-OGTT venous blood glucose level of 7.8-11.0 mmol/l. RESULTS: There were 2455 adults (>18) living in the 452 surveyed houses of which 10.2% reported having the diagnosis of DM. A total of 373 men and non-pregnant women underwent testing, and after adjustment for factors affecting participation probability the prevalence of diagnosed DM, undiagnosed DM and pre-diabetes was 10.5, 6.6 and 20.2%, respectively. Age-standardized rates for DM (diagnosed and undiagnosed) and pre-diabetes among 30-64 years old were 29.0 and 24.2%, respectively. Logistic regression analysis showed that only age and body mass index (BMI) were significantly independently related to undiagnosed DM. In patients with diagnosed DM, the prevalence rates for retinopathy, neuropathy, nephropathy, peripheral vascular disease and coronary heart disease were 54.2, 34.7, 40.8, 11.1 and 10.5%, respectively. A significant proportion of subjects with undiagnosed DM and pre-diabetes also had micro- and macro-vascular complications. The proportion of subjects with diagnosed DM who achieved internationally recognized targets for HbA1c (<7%), LDL-C (<2.6 mmol/l) and blood pressure (<130/80 mmHg) was 33.3, 30.8 and 42.1%, respectively. CONCLUSION: This study confirms the previously reported high prevalence of DM in the UAE. Diabetic complications were highly prevalent among subjects with diagnosed and undiagnosed DM. Metabolic control was suboptimal in most subjects with diagnosed DM. Greater efforts are urgently needed to screen early and effectively treat DM in the UAE in order to prevent long-term complications.